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Do cancer centers designated by the National Cancer Institute have better surgical outcomes?

  1. Nancy J. O. Birkmeyer Ph.D.1,†,*,
  2. Philip P. Goodney M.D.2,
  3. Therese A. Stukel Ph.D.3,
  4. Bruce E. Hillner M.D.4,
  5. John D. Birkmeyer M.D.1

Article first published online: 27 DEC 2004

DOI: 10.1002/cncr.20785

Issue

Cancer

Cancer

Volume 103, Issue 3, pages 435–441, 1 February 2005

Additional Information

How to Cite

Birkmeyer, N. J. O., Goodney, P. P., Stukel, T. A., Hillner, B. E. and Birkmeyer, J. D. (2005), Do cancer centers designated by the National Cancer Institute have better surgical outcomes?. Cancer, 103: 435–441. doi: 10.1002/cncr.20785

Author Information

  1. 1

    Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan

  2. 2

    Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire

  3. 3

    Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada

  4. 4

    Department of Internal Medicine, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, Virginia

  1. †

    Fax: (734) 763-5615

*Department of Surgery, University of Michigan Medical School, 2101 Taubman Health Care Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0346

Publication History

  1. Issue published online: 20 JAN 2005
  2. Article first published online: 27 DEC 2004
  3. Manuscript Accepted: 7 OCT 2004
  4. Manuscript Revised: 4 OCT 2004
  5. Manuscript Received: 13 SEP 2004

Funded by

  • National Cancer Institute. Grant Number: R01 CA098481
  • Agency for Healthcare Research and Quality. Grant Number: K02 HS11288

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Keywords:

  • National Cancer Institute;
  • patient care;
  • mortality rates;
  • survival rates

Abstract

BACKGROUND

The National Cancer Institute (NCI) designates cancer centers as regional centers of excellence in research and patient care. Although these centers often advertise their superior outcomes, their relative performance has not been examined empirically. In the current study, the authors assessed whether patients at NCI cancer centers compared with patients at control hospitals had lower mortality rates after major cancer surgery.

METHODS

Using the national Medicare database (1994–1999), the authors assessed surgical mortality and late survival rates for 63,860 elderly patients undergoing resection for lung, esophageal, gastric, pancreatic, bladder, or colon carcinoma. For assessing performance, patients treated at the 51 NCI cancer centers were compared with patients from 51 control hospitals with the highest volumes for each procedure. Mortality rates (surgical and 5-year rates) were adjusted for patient characteristics and residual differences in procedure volume.

RESULTS

NCI cancer centers had lower adjusted surgical mortality rates than control hospitals for 4 of the 6 procedures, including colectomy (5.4% vs. 6.7%; P = 0.026), pulmonary resection (6.3% vs. 7.9%; P = 0.010), gastrectomy (8.0% vs. 12.2%; P < 0.001), and esophagectomy (7.9% vs. 10.9%; P = 0.027). Nonsignificant trends toward lower adjusted operative mortality rates at NCI cancer centers were also observed for cystectomy and pancreatic resection. Among patients surviving surgery, however, there were no important differences in subsequent 5-year mortality rates between NCI cancer centers and control hospitals for any of the procedures.

CONCLUSIONS

For many cancer procedures, patients undergoing surgery at NCI-designated cancer centers had lower surgical mortality rates than those treated at comparably high-volume hospitals, but similar long-term survival rates. Cancer 2005. © 2004 American Cancer Society.

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